How to drop the sleep meds and improve your sleep naturally

A study published by the National Institutes of Health estimates that about 30 percent of adults in the United States suffer from insomnia. Insomnia is a frustrating condition for which many people take sleep medications. The National Health Interview Survey published by the CDC indicates that about 8.4 percent of adults take medication to sleep, either every day or most days of the month.

Women are more likely to use sleep medications and, in general, use increases with age. The downside of sleep medications is they are associated with an increase in dementia, especially Alzheimer’s disease. Since these medications can be habit forming, we asked primary care physician Holly Womack, MD, for advice on how people can wean off of these medications.

Dr. Womack practices at Strawberry Hill Primary Care in Hyannis, and also works as a hospitalist at Cape Cod Hospital four shifts a month.

“Insomnia is personal for me because I had it for a very, very long time,” she said.

When talking to patients who take Tylenol PM to help sleep, Dr. Womack always tells them that if they don’t need the therapeutic pain relief from Tylenol, then they shouldn’t be adding the extra negative side effects like possible liver and kidney damage that overuse of Tylenol can cause.

“Plus, the active ingredient in Tylenol PM can actually cause people to have more frequent wakings, so you’re actually waking up more,” she said.

Products like the over-the-counter sleep aid Unisom are slightly better than some of the other alternatives, Dr. Womack said, but they include some risks, including dependence and rebound insomnia.

“It’s usually just not as effective after the four-week mark,” she said. “It’s kind of a perception thing. People that take it think that they are sleeping more and sleep is a lot about perception.”

People think they are sleeping better, because they aren’t tossing and turning when they first go to bed, but the medications actually decrease both the quality and quantity of sleep over time because they interfere with the normal stages of sleep, potentially reducing deep sleep and REM sleep. Both deep sleep and REM sleep are crucial for our brains for physical and mental restoration, including memory consolidation.

It's very hard for people who have been taking those medications long-term to stop taking them. They can be reluctant to try and might be dependent on them. Dr. Womack recommends that patients do a risk/benefit analysis. Do the risks actually outweigh the benefits? Some patients need to be shown the data on the negative consequences of sleep medications, like addiction and dementia, to be convinced they should stop.

Weaning Techniques

Dr. Womack knows that when patients stop taking the medications, sleep anxiety can build. They often worry that they won’t sleep and then they will be drowsy and unable to perform their daily or work tasks the next day.

“Sometimes behavior therapy is something that we can do while they are still on (sleep medications) to prepare them to mitigate that anxiety around sleep before they actually stop taking it,” she said.

She also recommends slowly getting off the sleep medications, and the older you are the slower you should go. Patients are more likely to be successful getting off of the meds entirely if they go slowly.

To start, she recommends cutting down from seven nights a week to five nights a week. If you are having trouble tolerating that, go back up to six nights. But if five works, then next try four nights and eventually every other night.

She also talks to patients about how modern society makes us think we need a certain number of hours of continuous sleep all at once during the night. Focusing on a number, like getting eight hours of sleep every night, adds to sleep anxiety. Dr. Womack recommends focusing on how you feel the next day, rather than a specific number of hours.

“Some people are going to be the outsider or the exception, but for the most part, the older we get the less sleep we need,” she said. “That eight hours is accurate when your brain is still developing up until your 20s, but once you’re starting to get into that retirement age, usually people don’t have as high of a requirement for sleep. So, I tell them if you’re getting six hours but you feel good, then I’m happy with that. We don’t even have to talk about sleep.”

Sleep Hygiene

Most people who suffer from chronic insomnia get frustrated when doctors recommend good sleep hygiene, but it does actually work if you have the patience to stick with it. Dr. Womack recommends the following:

• Exercise more and nap less.
• Make sure you go to bed at the same time and wake up at the same time each day.
• Reduce blue light activity before bed. Turn off the TV and put down the cell phone.
• Limit the time you spend in bed not actually sleeping. You want your body to associate bed with sleeping and sex, and nothing else.
• Do a mindfulness meditation before bed that calms you with apps like Headspace and Calm. They relax you and become part of a bedtime routine your brain associates with sleep.
• Keep a sleep diary where you write down the time you go to bed, the time you woke up and the perceived number of hours of sleep.
• If you are still tossing and turning after 20 minutes, get up and do a non-stimulating activity like washing dishes or reading a book without a lot of action or suspense and then try again.

“If you are tossing and turning, it’s important to get up because the more you are lying in bed rolling around, the more your brain associates rolling around as an activity you do in bed,” she said.